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Objective This paper investigates the impact on emergency hospital services from initiation through recovery of a ransomware attack affecting the emergency department, intensive care unit and supporting laboratory services. Recovery strategies of paying ransom to the attackers with follow-on restoration and in-house full system restoration from backup are compared. Methods A multi-unit, patient-based and resource-constrained discrete-event simulation model of a typical U.S. urban tertiary hospital is adapted to model the attack, its impacts, and tested recovery strategies. The model is used to quantify the hospital's resilience to cyberattack. Insights were gleaned from systematically designed numerical experiments. Results While paying the ransom was found to result in some short-term gains assuming the perpetrators actually provide the decryption key as promised, in the longer term, the results of this study suggest that paying the ransom does not pay off. Rather, paying the ransom, when considered at the end of the event when services are fully restored, precluded significantly more patients from receiving critically needed care. Also noted was a lag in recovery for the intensive care unit as compared with the emergency department. Such a lag must be considered in preparedness plans. Conclusion Vulnerability to cyberattacks is a major challenge to the healthcare system. This paper provides a methodology for assessing the resilience of a hospital to cyberattacks and analyzing the effects of different response strategies. The model showed that paying the ransom resulted in short-term gains but did not pay off in the longer term.
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Deterrence, Backup, or Insurance: Game-Theoretic Modeling of Ransomware
In this paper, we present a game-theoretic analysis of ransomware. To this end, we provide theoretical and empirical analysis of a two-player Attacker-Defender (A-D) game, as well as a Defender-Insurer (D-I) game; in the latter, the attacker is assumed to be a non-strategic third party. Our model assumes that the defender can invest in two types of protection against ransomware attacks: (1) general protection through a deterrence effort, making attacks less likely to succeed, and (2) a backup effort serving the purpose of recourse, allowing the defender to recover from successful attacks. The attacker then decides on a ransom amount in the event of a successful attack, with the defender choosing to pay ransom immediately, or to try to recover their data first while bearing a recovery cost for this recovery attempt. Note that recovery is not guaranteed to be successful, which may eventually lead to the defender paying the demanded ransom. Our analysis of the A-D game shows that the equilibrium falls into one of three scenarios: (1) the defender will pay the ransom immediately without having invested any effort in backup, (2) the defender will pay the ransom while leveraging backups as a credible threat to force a lower ransom demand, and (3) the defender will try to recover data, only paying the ransom when recovery fails. We observe that the backup effort will be entirely abandoned when recovery is too expensive, leading to the (worst-case) first scenario which rules out recovery. Furthermore, our analysis of the D-I game suggests that the introduction of insurance leads to moral hazard as expected, with the defender reducing their efforts; less obvious is the interesting observation that this reduction is mostly in their backup effort.
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- Award ID(s):
- 2012001
- PAR ID:
- 10559003
- Publisher / Repository:
- MDPI
- Date Published:
- Journal Name:
- Games
- Volume:
- 14
- Issue:
- 2
- ISSN:
- 2073-4336
- Page Range / eLocation ID:
- 20
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.3390/g14020020
